Psychiatry AdvisorAdjunctive Antipsychotic Therapies in the Treatment of Major Depressive Disorder

Advances in Adjunctive Antipsychotic Therapies for Major Depressive Disorder: Implications for Clinical Practice

In an informative Q&A, Dr. Michael E. Thase from the Perelman School of Medicine at the University of Pennsylvania provides an in-depth analysis of the utilization of second-generation antipsychotics (SGAs) as adjunctive treatments in major depressive disorder (MDD). The discussion elucidates the conditions under which these therapies are prescribed, highlights their efficacy, and underscores the necessity of a cautious approach due to potential severe side effects, thus enriching the decision-making process for physicians.

Key Points:

• The FDA has approved five SGAs as adjunctive treatments for MDD in patients who do not adequately respond to traditional antidepressants. These include aripiprazole, quetiapine, olanzapine, brexpiprazole, and cariprazine.
• SGAs offer prompt symptom relief and are easy to implement, making them a favorable option for complex cases of MDD.
• Serious potential side effects, such as tardive dyskinesia (TD), require a careful risk-benefit analysis tailored to each patient’s clinical profile.
• Shared decision-making is crucial, taking into account the patient’s personal experience and their valuation of potential benefits and side effects.
• Current clinical evidence supports the efficacy of SGAs in providing symptom relief within 1 to 2 weeks of treatment initiation.
• Dr. Thase emphasizes that no SGA has emerged as superior; the choice often depends on factors like cost, track record, and side effects.
• Long-term treatment with SGAs is associated with risks such as weight gain and metabolic issues, necessitating regular monitoring.
• The optimal duration for adjunctive SGA therapy remains undetermined, highlighting the need for further research on long-term outcomes and side effect management.
• Shared decision-making in treatment strategy emphasizes the balance of benefits and risks, with consideration for the patient’s preferences and lifestyle impacts.

“It is our job as the prescribers to lay out the pros and cons of the options and then, among the cons, to try to make sure we have given pretty good balance to the differences between the members of the medications in the large class of SGAs and between the two subclasses.”
– Dr. Michael E. Thase, Perelman School of Medicine at the University of Pennsylvania

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